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This chapter studies the effects of acute and chronic substance use on sexual offending. A significant proportion of sexual offenders suffer from substance use disorders. Most of the studies that have a non–sexual violent offender control group showed that more sex offenders than non–sexual violent offenders abused alcohol. For drug abuse, mixed results were found. Substance use seems to be more prevalent in rapists than in child molesters and more frequent in nonparaphilic than in paraphilic sexual offenders. Ultimately, the nature of the relationship between substance use and sexual offending is complex and confounded with several factors. Acute and long-term effects of alcohol probably play a contributive but not a primary causal role in sexual offending. Substance abuse also plays a significant role in risk assessment and relapse prevention and should be considered in treatment options more specifically.